甲状腺功能亢进患者的社会心理因素特征

Characteristics of psychosocial factors of patients with hyperthyroidism

目的:利用量表测定法分析甲状腺功能亢进患者社会心理因素特征。方法:选择2004-01/12在营口市中心医院内分泌门诊及病房就诊的甲状腺功能亢进患者85例为测试对象(设为甲状腺功能亢进组),正常对照组选用同期营口市中心医院、营口市第一专科医院的部分工作人员及家属、中心医院非甲状腺功能亢进疾病患者的家属89例,在获得全面知情同意的前提下进行量表测定。包括①采用艾森克人格问卷4个维度计粗分,粗分>60分为情绪不稳定)评定患者人格特征。②采用症状自评量表(9个因子)评定患者心理健康状况。③采用社会支持评定量表(10个条目,以客观支持分,主观支持分、支持利用度分)评定患者对社会支持的感受程度。④采用应付方式问卷(共62项,以退避、幻想、自责、求助、合理化、解决问题6个因子)评定患者对疾病的应付方式。⑤采用简易应对方式问卷(包括20个条目,由积极应对和消极应对2个维度)评定患者的应对方式。⑥采用功能失调性态度量表(共40项,计总分)评定患者的认知情况。统一指导用语,无记名,所有量表测试后当场收回。结果:两组测查对象均完成各量表的评定,全部纳入结果分析。①艾森克人格问卷神经质量表分甲状腺功能亢进组明显高于对照组(P<0.01)。②症状自评量表躯体化、抑郁、焦虑、恐怖评分甲状腺功能亢进组高于对照组(P<0.05或0.01)。③社会支持量表评定甲状腺功能亢进组总分、主观支持、社会支持利用度评分比对照组低(P<0.05)。④应付方式问卷中自责、退避和幻想因子分均高于对照组,差异显著(P<0.05)。⑤甲状腺功能亢进组功能失调性态度量表总评分显著高于正常对照组(163.15±26.67,132.19±19.82,U=8.65,P<0.01)。⑥直线相关分析表明功能失调性态度量表值与艾森克人格问卷量表神经质值正相关(相关系数为0.54);与症状自评量表躯体化、抑郁、焦虑、恐怖等因子分正相关(相关系数分别为0.41,0.48,0.68,0.64);与社会支持评定量表对支持利用度因子分负相关(相关系数为-0.36);与应付方式问卷因子分(自责、合理化)正相关(相关系数分别为0.53,0.59)。结论:甲状腺功能亢进患者具有情绪不稳定的特征,其躯体化、抑郁、焦虑、恐怖等因子明显增高,尤其是认知曲解所致的应对方式不良、社会支持少、社会支持利用度小更加明显。

AIM： To analyze the features of psyehosocial factors in patients with hyperthyroidism by using measurement scales. METHODS： Eighty-five patients with hyperthyroidism admitted to the Outpatients Endocrinology Clinic or Ward of Yingkou Central Hospital from January to December 2004 were enrolled as hyperthyroidism group, and 89 worker or their relatives of Yingkou First Special Hospital, and relatives of non-hyperthyroidism patients in Yingkou Central Hospital were selected as control group. All the subjects agreed to participate in the study. Measurement scales in the study included Eysenck personality inventory （EPI） for personality characteristics （four dimensions, raw score 〉 60 as emotional instability）, symptom checklist （SCL） for mental health （nine factors）, social support rating scale （SSRS） for feeling about social support （10 items, including objective score, subjective score and support utilization score）, coping style questionnaire （CSQ） for coping style to disease （62 items, including 6 factors such as avoidance, illusion, self-accusation, asking for help, rationalization, solving problem）, mini-coping style questionnaire for coping style （20 items and passive-and negative-coping dimensions）, and functional disorder attitude measurement scale for cognition （40 items, total score）. Instructive words were accordant, and measurement questionnaires were taken back immediately after measurement without names recorded. RESULTS： All the subjects completed the questionnaires and enter the result analysis. Scores on neuroticism of EPI were higher in hyperthyroidism group than in the control group （P 〈 0.01）. In SCL examination, scores on somatization, depression, anxiety, and panic were higher in the hyperthyroidism group than in the control group （P 〈 0.05 or 0.01）. In SSRS measurement, total scores and scores on subjective support, social support utilization were significantly lower in the hyperthyroidism group than in the control group （P 〈 0.05）. In the CSQ examination, scores on self-accusation, avoidance, and illusion were significantly higher in the hyperthyroidism group than in the control group （P 〈 0.05）. The total score of functional disorder attitude measurement scale was 163.15±26.67 in the hyperthyroidism group than 132.19±19.82 in the control group （u=8.65, P 〈 0.01）. Linear correlation analysis indicated that scores on functional disorder attitude measurement scale were positively correlated with those on neuroticism of EPI, those on somatization, depression, anxiety, and panic of SCL, and those on self-accusation and rationalization of CSQ （correlation coefficient = 0.54, 0.41,0.48,0.68,0.64, 0.53, 0.59, respectively）, while there was a negative correlation between the scores of functional disorder attitude measurement scale and the scores on support utilization of SSRS （correlation coefficient=-0.36）. CONCLUSION： Patients with hyperthyroidism have the characteristics of emotional instability, and occurrence of somatization, depression, anxiety, and panic increases significantly, especially poorer coping style, less social support, smaller social support utilization.